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2.

3 Carbohydrates and lipids

Essential idea: Compounds of carbon, hydrogen and


oxygen are used to supply and store energy.

When you are building and drawing molecules it is essential to remember that it's the
bonds between the atoms where energy is stored. Organic molecules are often complex
and hence contain many bonds. The background image is a molecular model that shows
a small part of a cellulose molecule.
Understandings, Applications and Skills
Statement Guidance
2.3.U1 Monosaccharide monomers are linked together by Sucrose, lactose and maltose should be
condensation reactions to form disaccharides and included as examples of disaccharides
polysaccharide polymers. produced by combining monosaccharides.
The structure of starch should include
amylose and amylopectin.
2.3.U2 Fatty acids can be saturated, monounsaturated or Named examples of fatty acids are not
polyunsaturated. required.
2.3.U3 Unsaturated fatty acids can be cis or trans
isomers.
2.3.U4 Triglycerides are formed by condensation from
three fatty acids and one glycerol.
2.3.A1 Structure and function of cellulose and starch in
plants and glycogen in humans.
2.3.A2 Scientific evidence for health risks of trans fats and
saturated fatty acids.
2.3.A3 Lipids are more suitable for long-term energy
storage in humans than carbohydrates.
2.3.A4 Evaluation of evidence and the methods used to
obtain the evidence for health claims made about
lipids.
2.3.S1 Use of molecular visualization software to compare
cellulose, starch and glycogen.
2.3.S2 Determination of body mass index by calculation or
use of a nomogram.
2.1.U2 Carbon atoms can form four covalent bonds allowing a diversity of stable compounds to exist.

Despite only being the 15th most abundant element on the planet carbon
forms the backbone of every single organic molecule.
Covalent bonds are the strongest Carbon atoms contain four electrons
type of bond between atoms. in their outer shell allowing them to
Stable molecules can be formed. form four covalent bonds with
potential four other different atoms,
e.g. methane (CH4).

Because of the stability of covalent bonds large molecules with many


bonds can be formed. Titin is the largest known protein and it contains
539,000 atoms (chemical formula C169723 H270464 N45688 O52243 S912.). The
image below show a small part of the Titin molecule.

The result of these properties is an almost infinite


number of different possible molecules involving carbon.

http://commons.wikimedia.org/wiki/File:Carbon-atom.jpg
http://www.ks.uiuc.edu/images/ofmonth/2002-11/titin.jpg
http://upload.wikimedia.org/wikipedia/commons/3/3e/Methane-2D-dot-cross.png
2.3.U1 Monosaccharide monomers are linked together by condensation reactions to form disaccharides and
polysaccharide polymers.

Monosaccharide #1 Glucose has the formula C6H12O6


It forms a hexagonal ring (hexose)

Glucose is the form


of sugar that fuels
respiration
Glucose forms the
base unit for many
polymers

5 of the carbons form


corners on the ring
with the 6th corner
taken by oxygen
http://commons.wikimedia.org/wiki/File:Glucose_crystal.jpg
2.3.U1 Monosaccharide monomers are linked together by condensation reactions to form disaccharides and
polysaccharide polymers.

Monosaccharide #2 Galactose is also a


hexose sugar
Spot the difference It has the same
formula C6H12O6
but is less sweet

Most commonly
found in milk,
but also found
in cereals

http://commons.wikimedia.org/wiki/File:Galactose-3D-balls.png
http://commons.wikimedia.org/wiki/File:Alpha-D-glucose-3D-balls.pn
2.3.U1 Monosaccharide monomers are linked together by condensation reactions to form disaccharides and
polysaccharide polymers.

Monosaccharide #3 Fructose is another


pentose sugar

Commonly found in
fruits and honey

It is the sweetest
naturally occurring
carbohydrate
http://www.flickr.com/photos/max_westby/4045923/
http://commons.wikimedia.org/wiki/File:Red_Apple.jpg
http://commons.wikimedia.org/wiki/File:3dfructose.png
2.3.U1 Monosaccharide monomers are linked together by condensation reactions to form disaccharides and
polysaccharide polymers.

Monosaccharide #4 Ribose is a pentose


sugar, it has a
pentagonal ring

It forms the backbone


of RNA

Deoxyribose differs as
shown in the diagram,
and forms the
backbone of DNA
N.B. the above monosaccharides are included for continuity from
statement “2.1.S2 Identification of biochemicals such as sugars, lipids or
amino acids from molecular diagrams.”. They are not referred to in the
formation of the following disaccharides and polysaccharides.

Original owner of image unknown


2.3.U1 Monosaccharide monomers are linked together by condensation reactions to form disaccharides and
polysaccharide polymers.

water is removed glycosidic bond water is a


product
2.3.U1 Monosaccharide monomers are linked together by condensation reactions to form disaccharides and
polysaccharide polymers.

Disaccharide #1
Maltose (C12H22O11) is a dimer
of glucose

Gosh! Isn’t it sweet?! The two glucose


molecules are holding hands.

http://commons.wikimedia.org/wiki/File:Maltose_syrup.jpg
http://commons.wikimedia.org/wiki/File:Maltose_Haworth.svg
2.3.U1 Monosaccharide monomers are linked together by condensation reactions to form disaccharides and
polysaccharide polymers.

Disaccharide #2 Lactose (C12H22O11) is most


(Literally “two sugars”)
commonly found in milk

The two subunits that


make up lactose are
glucose and galactose,
our friends from a
couple of slides ago.

http://www.flickr.com/photos/vermininc/2764742483/
http://commons.wikimedia.org/wiki/File:Alpha-lactose-from-xtal-3D-balls.png
2.3.U1 Monosaccharide monomers are linked together by condensation reactions to form disaccharides and
polysaccharide polymers.

Disaccharide #3 Sucrose (C12H22O11) is also


known as table sugar

The two subunits that


The two monosaccharides
make up sucrose are
that make it up are
glucose and fructose.
glucose and fructose

http://commons.wikimedia.org/wiki/File:Sucrose.gif
http://www.flickr.com/photos/carowallis1/4388310394/
2.3.U1 Monosaccharide monomers are linked together by condensation reactions to form disaccharides and
polysaccharide polymers.
2.3.A1 Structure and function of cellulose and starch in plants and glycogen in humans.

• Cellulose is made by linking together β-glucose


Polysaccharide #1 •
molecules.
Condensation reactions link carbon atom 1 to
carbon atom 4 on the next β-glucose.
Cellulose • The glucose subunits in the chain are oriented
alternately upwards and downwards.
• The consequence of this is that the cellulose
molecule is a straight chain, rather than curved.

• Cellulose molecules are unbranched chains of β-glucose. n.b. Vertebrates (including humans)
• Hydrogen bonds link the the molecules together. are unable to digest cellulose
• The linked molecules form bundles called cellulose microfibrils. because they don’t possess enzymes
to breakdown glycosidic bonds
• They have very high tensile strength.
between β-glucose molecules.
• The tensile strength of cellulose (the basis of cell walls) Grazing animals often host bacteria
prevents plant cells from bursting, even under very high (water) in their guts which do possess these
pressure. enzymes.
http://en.wikipedia.org/wiki/File:Cellulose_spacefilling_model.jpg
2.3.A1 Structure and function of cellulose and starch in plants and glycogen in humans.

Amylose and
Polysaccharide #2 Amylopectin are both
forms of starch and
made from repeating
glucose units

• Starch is made by linking together α-glucose molecules


• Condensation reactions link carbon atom 1 to carbon atom 4 on the next α-
glucose
• all the glucose molecules in starch can be orientated in the same way
• The consequence of this is that the starch molecule is curved, rather than straight.
• Size of the molecule is not fixed

http://www.flickr.com/photos/caroslines/5534432762/
http://commons.wikimedia.org/wiki/File:Amylose3.svg
2.3.A1 Structure and function of cellulose and starch in plants and glycogen in humans.

Polysaccharide #2 • In amylose the chain of α-glucose


molecules is un-branched and forms a helix.
• Typically amylose is made up of 300-3,000
• In amylopectin the chain is branched, glucose units
so has a more globular shape.
• Due it’s branched nature amylopectin
can be much larger consisting of
2,000-200,000 units

• Starch is only made by plant cells.


• Molecules of both types of starch are hydrophilic but are too large to be soluble in water.
• Starch does not affect the osmotic balance of cells, i.e. cause too much water to enter
them
• It is easy to add or remove extra glucose molecules to starch
• Therefore starch is useful in cells for glucose, and consequently energy, storage.
• In seeds and storage organs such as potato cells glucose held as starch.
• Starch is made as a temporary store in leaf cells when glucose is being made faster by
photosynthesis than it can be exported to other parts of the plant.
http://www.flickr.com/photos/caroslines/5534432762/
2.3.A1 Structure and function of cellulose and starch in plants and glycogen in humans.

• Glycogen (C6H10O5)n is a polymer made from


Polysaccharide #3 repeating glucose subunits
• The molecule varies in size, typically it
consists of 30,000 units

• Glycogen is not just a simple chain, it


branches many times
• Condensation reactions link carbon atom
1 - 4 on the next α-glucose. Branches
occur where a condensation reaction
instead links carbon atom 1 – 6. • Glycogen is made by
• As a result the molecule is compact
animals and also some
fungi.
• It is stored in the liver
and some muscles in
humans.
• It is used in cells where
large stores of
• Glycogen does not affect the osmotic balance of cells, i.e. cause too dissolved glucose
much water to enter them would cause osmotic
• It is easy to add or remove extra glucose molecules to starch problems.
• Therefore glycogen is useful in cells for glucose, and consequently http://en.wikipedia.org/wiki/File:Glyc
energy, storage. ogen_spacefilling_model.jpg
2.3.S1 Use of molecular visualization software to compare cellulose, starch and glycogen.

Comparing molecules – using visualisation software


The easiest way to use Jmol is to use the ready-made models from
on the biotopics website
• Click on the models or the logo below to access them
• Play with the models, move them, zoom in and out
• Test yourself by answering the questions below:

1. Select the the glucose molecule and identify the colours


used to represent carbon, hydrogen and oxygen atoms
2. Using the models identify and describe the differences
between glucose, sucrose and fructose (hint: descriptions
will be clearest if you refer to the numbered carbon atoms,
see 2.3.U1)
3. Look at the amylose model and zoom out from it. Describe
the overall shape of the molecule.

http://www.biotopics.co.uk/jsmol/glucose.html
2.3.S1 Use of molecular visualization software to compare cellulose, starch and glycogen.

Comparing molecules – using visualisation software


4. Zoom in on the amylose molecule. Each glucose
sub-unit is bonded to how many other sub-units?
Which carbons atoms used to form the glycosidic
bonds? Are there any exceptions to these rules?
5. Select the amylopectin model and zoom in on the
branch point. This glucose sub-unit is bonded how
to many others? Which carbon atoms are used for
bonds? How does this compare to the carbons
used for bonding in the un-branched amylose
molecule?
6. Using a similar approach to that above investigate
the structure of glycogen and find the similarities
and differences between it and both amylose and
amylopectin.
Review: 2.1.S2 Identification of biochemicals such as sugars, lipids or amino acids from molecular diagrams.

Identifying molecules from diagrams


General structural formula for a fatty* acid
O
H 3C (CH2)n C
Chain (or ring) of carbon OH
and hydrogen atoms
Carboxylic group

*I prefer “big boned” http://www.eufic.org/article/pt/nutricao/gorduras/expid/23/


2.3.U2 Fatty acids can be saturated, monounsaturated or polyunsaturated.

Identifying molecules from diagrams


Saturated, monounsaturated or polyunsaturated?

Q1 Oleic Acid

Q2 Caproic Acid

Q3 α-Linolenic Acid
2.3.U2 Fatty acids can be saturated, monounsaturated or polyunsaturated.

Identifying molecules from diagrams


Saturated, monounsaturated or polyunsaturated?

Q1 Oleic Acid 1 double bond therefore monounsaturated

Q2 Caproic Acid no double bonds therefore unsaturated

Q3 α-Linolenic Acid 3 double bonds therefore polyunsaturated

n.b. the term saturated refers to


whether more hydrogen can be
added to the fatty acid. A double
bond can be replaced if two
hydrogen atoms are added. If there
are no double bonds a fatty acid is
said to be saturated as no more
hydrogen atoms can be added.
https://commons.wikimedia.org/wiki/Fatty_acids#Polyunsaturated_fatty_acids_2
2.3.U3 Unsaturated fatty acids can be cis or trans isomers.

Identifying molecules from diagrams – cis and trans isomers


Cis-isomers Trans-isomers

Very common in nature Rare in nature – usually artificially produced to produce


solid fats, e.g. margarine from vegetable oils.
the hydrogen atoms are on the same side of the two the hydrogen atoms are on the opposite side of the
carbon atoms two carbon atoms
The double bond causes a bend in the fatty acid chain The double bond does not causes a bend in the fatty
acid chain
Therefore cis-isomers are only loosely packed Trans-isomers can be closely packed

Triglycerides formed from cis-isomers have low Triglycerides formed from trans-isomers have high
melting points – they usually liquid at room melting points – they usually solid at room
temperature temperature
2.3.U3 Unsaturated fatty acids can be cis or trans isomers.

Identifying molecules from diagrams – cis and trans isomers


Q1 trans or cis isomers?

???

???
2.3.U3 Unsaturated fatty acids can be cis or trans isomers.

Identifying molecules from diagrams – cis and trans isomers


Q1 trans or cis isomers?
2.3.U3 Unsaturated fatty acids can be cis or trans isomers.

Identifying molecules from diagrams – cis and trans isomers


Q2 trans or cis isomer of α-Linolenic Acid?
2.3.U3 Unsaturated fatty acids can be cis or trans isomers.

Identifying molecules from diagrams – cis and trans isomers


Q2 trans or cis isomer of α-Linolenic Acid?

All 3 double bonds are cis, each one causes a bend in


the fatty acid chain.
2.3.A4 Evaluation of evidence and the methods used to obtain the evidence for health claims made about lipids.
AND Nature of science: evaluating claims - health claims made about lipids in diets need to be assessed. (5.2)

Evaluating health claims

Which health claims


are valid?

http://www.foxnews.com/health/2013/02/18/raspberry-ketone-be-wary-this-diet-trend/

http://www.forbes.com/2004/04/21/cz_af_0421feat.html

http://www.badscience.net/2009/08/health-warning-exercise-makes-you-fat/
2.3.A4 Evaluation of evidence and the methods used to obtain the evidence for health claims made about lipids.
AND Nature of science: evaluating claims - health claims made about lipids in diets need to be assessed. (5.2)

Evaluating health claims


Evidence for health claims comes from research. Some of this research is more
scientifically valid than others.

Key questions to consider for the Evaluation = Make an appraisal by weighing


strengths are: up the strengths and limitations
• Is there a (negative or positive) correlation
between intake of the lipid being
investigated and rate of the disease or the Key questions to consider for the limitations are:
health benefit? • Was the measure of the health a valid one? e.g. cholesterol
• If instead mean values are being compared levels in blood are more informative than body mass index
how different are they? Has this difference • How large was the sample size? Larger samples are more
been assessed statistically? reliable.
• How widely spread is the data? This can be • Does the sample reflect the population as a whole or just a
assessed by the spread of data points or particular sex, age, state of health, lifestyle or ethnic
the relative size of error bars. The more background?
widely spread the data the smaller the • Was the data gathered from human or animal trials? If only
significance can be placed on the done of animals how applicable are the findings?
correlation and/or the conclusion. • Were all the important control variables, e.g. level of
activity, effectively controlled?
n.b. it is easiest to consider strengths by looking • Were the levels and frequency of the lipids (or substance
at effectively drawn graphs. studied) intake realistic?
• How rigorous were the methods used to gather data? e.g. If
only a survey was used how truthful were the respondents?
2.3.A2 Scientific evidence for health risks of trans fats and saturated fatty acids.

health risks of trans fats and saturated fatty acids


There have been many claims about the effects of different types of fat on human health. The main
concern is coronary heart disease (CHD). In this disease the coronary arteries become partially blocked
by fatty deposits, leading to blood clot formation and heart attacks.

• A positive correlation has been found between saturated fatty acid intake and rates of CHD in many
studies.
• Correlation ≠ causation. Another factor, e.g. dietary fibre could be responsible.
• There are populations that do not fit the correlation such as the Maasai of Kenya. They have a diet
that is rich in meat, fat, blood and milk. They therefore have a high consumption of saturated fats, yet
CHD is almost unknown among the Maasai.
• Diets rich in olive oil, which contains cis-monounsaturated fatty acids, are traditionally eaten in
countries around the Mediterranean. The populations of these countries typically have low rates of
CHD and it has been claimed that this is due to the intake of cis-monounsaturated fatty acids.
• Genetic factors in these populations could be responsible.
• Other aspects of the diet could explain the CHD rates.
• There is also a positive correlation between amounts of trans-fat consumed and rates of CHD.
• Other risk factors have been tested, to see if they can account for the correlation, but none did.
Trans-fats therefore probably do cause CHD.
• In patients who had died from CHD, fatty deposits in the diseased arteries have been found to
contain high concentrations of trans-fats, which gives more evidence of a causal link.

Also check the good explanation of Lipid health risks from Bioninja
http://oliveoilsindia.com/green-olives/green-olives.jpg
2.3.U4 Triglycerides are formed by condensation from three fatty acids and one glycerol.

Triglycerides formation
Condensation reaction between glycerol and fatty acids

Glycerol Three Fatty Acids Triglyceride

Lipids are glycerol combined with 1, 2 or 3 fatty 3H2O


acids, therefore triglycerides are lipids
n.b. hydrolysis is the reverse of this process, catalysed
by lipase Covalent bonds called ester bonds are
formed between the fatty acids and
glycerol molecules.
2.3.A3 Lipids are more suitable for long-term energy storage in humans than carbohydrates.

Energy storage by lipids and carbohydrates


Functions of lipids:
• Structure: Phospholipids are a main
component of cell membranes
• Hormonal signalling: Steroids are
involved in hormonal signalling (e.g.
estrogen, progesterone, testosterone)
• Insulation: Fats in animals can serve as
heat insulators while sphingolipids in the
myelin sheath (of neurons) can serve as
electrical insulators
• Protection: Triglycerides may form a
tissue layer around many key internal
organs and provide protection against
physical injury • Lipids are normally used for long-term
• Storage of energy - triglycerides can be energy storage whereas carbohydrates are
used as a long-term energy storage used for short-term energy storage.
source • The lipids that are used are fats. They are
stored in specialized groups of cells called
adipose tissue. Adipose tissue is located
immediately beneath the skin and also
around some organs including the kidneys.
http://www.flickr.com/photos/johnnystiletto/5411371373/
2.3.A3 Lipids are more suitable for long-term energy storage in humans than carbohydrates.

Energy storage by lipids and carbohydrates


Reasons for using lipids for long-term energy
storage:
• The amount of energy released in cell
respiration per gram of lipids is double that
for carbohydrates (and protein)
• Lipids add 1/6 as much to body mass as
carbohydrates: fats are stored as pure
droplets whereas when 1g glycogen is
stored it is associated with 2g of water. This
is especially critical for active animals as
energy stores have to be carried.

(energy contained in) 1g lipids


Mass used for storage =
(energy contained in) 2g carbohydrate + 4g associated water

=1/6

https://commons.wikimedia.org/wiki/Bat#mediaviewer/File:PikiWiki_Israel_11327_Wildlife_and_Plants_of_Israel-Bat-003.jpg
2.3.A3 Lipids are more suitable for long-term energy storage in humans than carbohydrates.

Energy storage by lipids and carbohydrates


Why is glycogen is needed at all?

• This is because glycogen can be broken down to


glucose rapidly
• and then transported easily by the blood to where
it is needed
• Fats in adipose tissue cannot be mobilized as
rapidly
• Glucose can be used either in anaerobic or aerobic
cell respiration whereas fats and fatty acids can
only be used in aerobic respiration
2.3.A3 Lipids are more suitable for long-term energy storage in humans than carbohydrates.

Energy storage by lipids and carbohydrates


Glycogen is the medium-term energy storage molecule in animals. It is stored in the
liver and muscles. The energy stored in glycogen is more readily available than the
energy stored in fat.

Glucose in the bloodstream is for immediate use and will either be used in
respiration to yield ATP or converted to glycogen or fat

An analogy: you
r Wallet easy to get to,
would be too big if you put
it in (Glycogen)
Put in all your money

You are
paid in cash Deposit in t
he
(Glucose)
Bank
(Fat)

Can put lots of money here, more


of a hassle to get it back out
Spend it!
(Respiration)
2.3.S2 Determination of body mass index by calculation or use of a nomogram.

Body Mass Index – calculation and usage


In some parts of the world food supplies are Body Mass Index (BMI) is used as a
insufficient or are unevenly distributed and many screening tool to identify possible weight
people as a result are underweight. problems, however, BMI is not a diagnostic
tool. To determine if excess weight is a
In other parts of the world a likelier cause of being health risk further assessments are needed
underweight is anorexia nervosa. This is a such as:
psychological condition that involves voluntary • skinfold thickness measurements
starvation and loss of body mass. • evaluations of diet
• physical activity
Obesity is an increasing problem in some countries. • and family history
Obesity increases the risk of conditions such as
coronary heart disease and type II diabetes. It The table below can be used to assess an
reduces life expectancy significantly and is increasing adult’s status
the overall costs of health care in countries where
rates of obesity are rising. BMI Status

Below 18.5 Underweight

18.5 – 24.9 Normal

25.0 – 29.9 Overweight

30.0 and Above Obese


2.3.S2 Determination of body mass index by calculation or use of a nomogram.

Body Mass Index – calculation and usage


BMI is calculated the same way for both
adults and children. The calculation is
based on the following formula:

BMI = mass in kilograms


(height in metres)2

n.b. units for BMI are kg m-2

Example:

Mass = 68 kg, Height = 165 cm (1.65


m)

BMI = 68 ÷ (1.65)2 = 24.98 kg m-2

In this example the adult would be


(borderline) overweight - see the
table on the previous slide

Charts such as the one to the right can


also be used to assess BMI.
http://sphweb.bumc.bu.edu/otlt/MPH-Modules/PH/PH709_Heart/Childhood-BMI-Nomogram.jpg
2.3.S2 Determination of body mass index by calculation or use of a nomogram.

Body Mass Index – calculation and usage


An alternative to calculating the
BMI is a nomogram. Simply use a
ruler to draw a line from the body
mass (weight) to the height of a
person. Where it intersects the
W/H2 line the person’s BMI can
be determined. Now use the
table to assess their BMI status.

BMI Status

Below 18.5 Underweight

18.5 – 24.9 Normal

25.0 – 29.9 Overweight

30.0 and Obese


Above

http://helid.digicollection.org/documents/h0211e/p434.gif
2.3.S2 Determination of body mass index by calculation or use of a nomogram.

Body Mass Index – calculation and usage


1. A man has a mass of 75 kg and a
height of 1.45 metres.
a. Calculate his body mass index.
(1)

b. Deduce the body mass status of


this man using the table. (1)

c. Outline the relationship


between height and BMI for a
fixed body mass. (1)
2.3.S2 Determination of body mass index by calculation or use of a nomogram.

Body Mass Index – calculation and usage


1. A man has a mass of 75 kg and a BMI = mass in kilograms ÷ (height in metres)2
height of 1.45 metres. = 75 kg ÷ (1.45 m)2
a. Calculate his body mass index. = 75 kg ÷ 2.10 m2
(1) = 35.7 kg m-2

b. Deduce the body mass status of 35.7 kg m-2 is above 30.0 (see table below)
this man using the table. (1) therefore the person would be classified obese.

BMI Status
c. Outline the relationship
between height and BMI for a Below 18.5 Underweight
fixed body mass. (1) 18.5 – 24.9 Normal
The taller a person the smaller the 25.0 – 29.9 Overweight
BMI;
30.0 and Above Obese
(negative correlation, but not a
linear relationship)
2.3.S2 Determination of body mass index by calculation or use of a nomogram.

Body Mass Index – calculation and usage


2. A woman has a height of 150 cm and
a BMI of 40.
a. Calculate the minimum amount
of body mass she must lose to
reach normal body mass status.
Show all of your working. (3)

b. Suggest two ways in which the


woman could reduce her body
mass. (2)
2.3.S2 Determination of body mass index by calculation or use of a nomogram.

Body Mass Index – calculation and usage


4. A woman has a height of 150 cm and BMI = mass in kilograms ÷ (height in metres)2
a BMI of 40.
a. Calculate the minimum amount therefore
of body mass she must lose to
reach normal body mass status. mass in kilograms = BMI ÷ (height in metres)2
Show all of your working. (3)

Actual body mass = BMI ÷ (height in metres)2


= 40 kg m-2 x (1.50 m)2
b. Suggest two ways in which the = 90 kg
woman could reduce her body
mass. (2) Normal BMI is a maximum of 24.9 kg m-2
Reduce her nutritional intake /
diet / reduce the intake of lipids; Normal body mass = 24.9 kg m-2 x (1.5 m)2
Exercise / increase activity levels; = 56 kg

To reach normal status the woman needs to lose


90 kg – 56 kg = 34 kg
Bibliography / Acknowledgments

Jason de Nys

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